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To compare the safety and radiological effectiveness of lumbar interbody fusion with a 3D-printed porous titanium (3D-PPT) cage versus a polyetheretherketone (PEEK) cage for the treatment of lumbar degenerative disease. This study was registered at PROSPERO (CRD42023461511). We systematically searched the PubMed, Embase, and Web of Science databases for related studies from inception to September 3, 2023. Review Manager 5.3 was used to conduct this meta-analysis. The reoperation rate, complication rate, fusion rate, and subsidence rate were assessed using relative risk and 95% confidence intervals. Ten articles reporting 9 studies comparing lumbar interbody fusion with 3D-PPT cages versus PEEK cages for the treatment of lumbar degenerative disease were included. The subsidence rate at the 1-year follow-up in the 3D-PPT cage was significantly lower than that in the PEEK cage. The fusion rate in the 3D-PPT cage was significantly higher than that in the PEEK cage at the 6-month follow-up. No significant difference was identified between the 2 groups at the 12-month follow-up. No significant difference was identified between the 2 groups in terms of the complication rate and reoperation rate. There was a trend toward a lower complication rate and reoperation rate with the 3D-PPT cage. Compared with the PEEK cage, the 3D-PPT cage may be a safer implant. The 3D-PPT cage was associated with a higher fusion rate and lower subsidence rate. The 3D-PPT cage may accelerate the intervertebral fusion process, improve the quality of fusion and prevent the occurrence of subsidence. [ABSTRACT FROM AUTHOR]

Surgery is the definitive treatment option for symptomatic Chiari malformation I (CMI), but there is no clear consensus as to the preferred surgical method. This study aimed to quantitatively assess and compare the effect and safety of dura splitting decompression (DSD) and posterior fossa decompression with duraplasty (PFDD) in treating patients with CMI. A literature search of EMBASE, MEDLINE, PubMed, Cochrane Library, and Web of Science databases was conducted. References from January 1990 to September 2020 were retrieved. We only included papers containing original data, comparing the use of DSD and PFDD in CMI patients. Overall, 11 relevant studies were identified, wherein 443 patients treated for CMI by DSD were compared with 261 patients treated by PFDD. No difference was observed between PFDD and PFD in terms of clinical improvement (P = 0.69), syringomyelia improvement (P = 0.90), or reoperation (P = 0.22). DSD was associated with shorter operation durations (P = 0.0007), shorter length of stay (P = 0.0007), and shorter overall postoperative complications (P < 0.0001) (especially cerebrospinal fluid [CSF] leak P = 0.005], meningitis P = 0.002], and pseudomeningocele P = 0.002]), as compared with PFDD. This study confirmed that dura splitting decompression has clinical and syringomyelia improvement outcomes comparable to posterior fossa decompression with duraplasty. Compared with PFDD, DSD not only significantly shortened the operation time and length of stay, but also significantly reduced the overall complication rate, especially those related to incidence of CSF-related complications. More evidence from advanced multicenter studies are needed to require to validate the findings. [ABSTRACT FROM AUTHOR]

Cell-derived exosomes bearing microRNAs (miRNAs) have emerged as a potential therapeutic option for cerebral ischemia-reperfusion injury (CIRI). However, their mechanism of action and clinical translation value remain unclear. The present meta-analysis investigated the therapeutic effects of miRNA-modified exosomes used in preclinical animal models of CIRI. The PubMed, Embase, and Web of Science databases were searched on April 20, 2022, to retrieve studies involving middle cerebral artery occlusion model animals treated with exosomes bearing miRNAs. The primary outcome was infarct volume, and the secondary outcome was neurobehavioral performance. FunRich software was used for bioinformatic analysis of exosomal miRNAs, and statistical analysis was performed using R version 4.1.1 (R Foundation for Statistical Computing). Eleven relevant studies were included in the meta-analysis. miRNA-modified exosomes significantly reduced infarct volume (standardized mean difference [SMD], 4.50 [95% confidence interval, 3.02–5.99]; P < 0.01) and improved neurological score (SMD, 2.80 [95% confidence interval, 1.37–4.23]; P < 0.01). Subgroup analysis revealed that a higher injection frequency of exosomes could better reduce infarct volume. The top 6 biological pathways, expression sites, and transcription factors of related exosomal miRNAs were identified through bioinformatics analysis. An asymmetrical funnel plot and Egger's test (P = 0.10) revealed publication bias. Trim-and-fill analysis identified 5 unpublished studies addressing the primary outcome. miRNA-modified exosomal therapy demonstrated the potential to improve infarct volume and neurobehavioral performance in preclinical animal models of CIRI. Despite the heterogeneity among studies, the results may provide some direction for future clinical research. [ABSTRACT FROM AUTHOR]